RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2014-00104
BRANCH OF SERVICE:  Army	BOARD DATE:  20141202
SEPARATION DATE:  20080207

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (63B/Wheeled Vehicle Mechanic) medically separated for a left knee condition.  The left knee condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  He was issued a permanent L3 profile (which allowed for an alternate aerobic event to satisfy physical fitness standards) and referred for a Medical Evaluation Board (MEB).  The left knee condition, characterized as “left knee degenerative joint disease” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded one other medically acceptable condition, hyperlipidemia.  The Informal PEB (IPEB) adjudicated “degenerative joint disease, left knee” as unfitting, rated at 0%.  The remaining condition was determined to be not unfitting.  The US Army Physical Disability Agency (USAPDA) reviewed the IPEB proceedings and issued a DA Form 199-2 (documentation of USAPDA revision to PEB proceedings), which had no bearing on the rating.  The CI made no appeals and was medically separated.

CI CONTENTION:  “Still having problems with my left knee as well as my right knee.  Use a cane on a daily basis, please consider all conditions.  Both knees are messed up with torn ligaments.”  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e.(2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting left knee condition is addressed below.  The hyperlipidemia which was determined to be not unfitting by the PEB is likewise addressed below.  The right knee was not identified by the PEB, and thus is not within the DoDI 6040.44 defined purview of the Board.  No additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

RATING COMPARISON:

PDA Admin Corr – Dated 20080411	VA – (At-Separation) 	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Degenerative Joint Disease, Left Knee	5010	0%	Degenerative Joint Disease, Traumatic, Left Knee	5010-5260	10%	20080211	
Hyperlipidemia	Not Unfitting	No VA Entry 		
Other x 0 (Not in Scope)	Other x 4	20080211	
Rating:  0%	Rating:  10%	
Derived from VA Rating Decision (VARD) dated 20080430 (most proximate to date of separation)

ANALYSIS SUMMARY:

Degenerative Joint Disease, Left Knee Condition.  The record indicated the CI had trauma to his left knee with a meniscus and posterior cruciate ligament (PCL) tear.  He underwent surgery in 2005 including meniscal debridement with complications of a deep venous thrombosis.  The CI’s second knee surgery in November 2006 included microfracture of a patellofemoral joint lesion (to improve bony surfaces).  At the MEB exam (DD Forms 2807 and 2808) 7 months prior to separation, the CI complained of traumatic arthritis of the left knee, wearing a (prescribed) brace; knee pain was with “associated swelling, popping and grinding” aggravated by activities.  Radiographs documented tri-compartment arthritis, tear of the PCL and prior meniscal tear.  Left knee exam documented crepitus and tenderness to palpation with full active and passive range-of-motion (“AFROM/PFROM”).  The narrative summary (NARSUM) completed 5 months prior to separation (by a different provider than the DD Form 2808) documented a similar history with no significant history of locking or giving way of the knee, but with a grinding sensation and pain with activities.  Exam noted slight atrophy of the thigh muscle (quadriceps), diffusely tender anterior knee and ROM of “0-125 degrees (normal 0-140 degrees) with pain elicited at the extreme range of motion.”  There was no exam evidence of instability (normal testing).  The PEB disability description stated:  “Range of motion 0-125 degrees (considered full range of motion per DD Form 2808).”

At the VA Compensation and Pension exam (performed 4 days after separation), the CI reported similar injury and surgical history with ongoing pain and crepitus of the knee.  Exam documented “palpable and audible crepitation with range of motion,” pain on squatting and limited flexion of 0-120 degrees out of 140 degrees with extension of 0 degrees out of 0 degrees.  The CI was able to walk on heels and toes and there was no additional limitation following repetitions.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB noted “full range of motion” on the DD Form 2808 did not account for the crepitus or tenderness of that exam and applied it to the NARSUM exam’s finding of 0 to 125 degrees which was performed by a different examiner.  The Veterans Affairs Schedule for Rating Disabilities (VASRD) normal ROMs are 0 to 140 degrees and no statement relating to a more limited range being normal were noted by the NARSUM examiner.  The CI had clear evidence of pain-limited motion on both the NARSUM and VA exams which were closer to the DOS than the DD Form 2808 exam.  None of the ROM limits were compensable under the specific knee codes and there was no evidence of instability proximate to separation for a dual rating of the knee.  The Board considered there was insufficient evidence to support a 20% meniscal coding under 5258 (cartilage, semilunar) as there was not frequent episodes of “locking” or effusion into the joint.  Coding under 5259 (cartilage, semilunar) at 10% was supported by surgical evidence and ongoing symptoms.  However, the major symptoms were arthritic (crepitus and painful motion) and coding at 10% under 5010 (arthritis, due to trauma) was predominate.  There was no benefit for alternative coding under 5259 or 5259-5010.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 10% for the left knee condition.

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that hyperlipidemia was not unfitting.  Hyperlipidemia is an abnormal laboratory finding and not a condition constituting a compensable medical condition.  The condition was not profiled or implicated in the commander’s statement and was not judged to fail retention standards.  There were no diagnosed sequelae attributable to the hyperlipidemia.  After due deliberation in consideration of the preponderance of the evidence, the Board concluded there was insufficient cause to recommend a change in the PEB fitness determination for the hyperlipidemia condition and so no additional disability ratings are recommended.

BOARD FINDINGS:  IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication.  In the matter of the left knee condition, the Board unanimously recommends a disability rating of 10%, coded 5010 IAW VASRD §4.71a.  In the matter of the contended hyperlipidemia condition, the Board unanimously agrees that it cannot recommend it for additional disability rating.  There were no other conditions within the Board’s scope of review for consideration.

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as follows, effective as of the date of his prior medical separation:

UNFITTING CONDITION	VASRD CODE	RATING	
Degenerative Joint Disease, Left Knee	5010	10%	
RATING	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140411, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

XXXXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXXXXXX, AR20150007637 (PD201400104)

1.  I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual.  Under the authority of Title 10, United States Code, section 1554a,   I accept the Board’s recommendation to modify the individual’s disability rating to 10% without recharacterization of the individual’s separation.  This decision is final.  

2.  I direct that all the Department of the Army records of the individual concerned be corrected accordingly no later than 120 days from the date of this memorandum.   

3.  I request that a copy of the corrections and any related correspondence be provided to the individual concerned, counsel (if any), any Members of Congress who have shown interest, and to the Army Review Boards Agency with a copy of this memorandum without enclosures.

 BY ORDER OF THE SECRETARY OF THE ARMY:

Encl						     XXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						         (Review Boards)

CF: 
(  ) DoD PDBR
(  ) DVA